Dr Zowie Davy, Research Fellow, School of Health & Social Care, University of Lincoln.

Viet-Hai Phung, Research Assistant, School of Health & Social Care, University of Lincoln.

Overarching aim

We aimed to use a blended learning approach combining face-to-face lectures, seminars or workshops (1-3 hours), which included: teaching; small group work; video and self-assessment supported by an e-learning package; or alternatively an e-learning package alone delivered as a web-based package through the REST website.

We sought to further develop, pilot and implement a novel learning approach for delivery of education to primary care nurses and general practitioners to provide sleep assessment and CBT-i to patients in general practice. The approach was to be piloted with a sample of practitioners before being implemented more widely and evaluated in the Trent region in preparation for national dissemination.

Objectives

To encourage GPs to shift away from prescribing hypnotic drugs for treating insomnia in favour Cognitive Behavioural Therapy for Insomnia (CBT-I). It is envisaged that patients themselves will take a more proactive role in managing their condition.

Methods

The evaluation used a mixed methods approach using pre- and post-learning surveys, e-learning usage, analysis of prescribing and prescribing cost data and practitioner interviews.

Outcomes

Overall, during the period of IPCREST (April 2011 to March 2012), hypnotic and anxiolytic prescribing costs across the East Midlands counties involved above fell over ten percent (10.3 per cent) from £4.34 million in 2010/11 to £3.89 million. The number of prescription items actually increased in all the areas involved in IPCREST (Figures 10 & 11) which, taken together with falling costs, suggests that prescriptions of hypnotic and anxiolytic drugs were dispensed with less expensive products or smaller pack sizes (i.e. fewer tablets per prescription).

Outputs

Impact case study

Impact

IPCREST aimed to provide effective, patient-centred care to improve sleep quality and quality of life and reduce long-term inappropriate hypnotic prescribing.The innovation was to implement a new system for assessment and psychological treatment for insomnia in primary care. More effective treatment of insomnia is associated with reduced cardiovascular risks (obesity, hypertension) and complications (coronary heart disease), mental health problems (anxiety and depression) as well as work absence; it is also linked to improved function at work, and reduced inappropriate long-term prescribing of hypnotics with their potential for side- effects (daytime sedation, accidents and falls).Better management of insomnia has the potential to improve quality of life, reduce work absence, improve poor function at work (presenteeism) and reduce the substantial economic costs of decreased productivity in service users as well as reducing the costs of long-term hypnotic prescribing (£22 million per annum) and reducing the associated repeat consultations, adverse effects and the potential interactions of hypnotic drugs.